title: Usage patterns of 'over-the-counter' vs. prescription-strength nonsteroidal anti-inflammatory drugs in France.
abstract: OBJECTIVE
  Most risks of nonsteroidal anti-inflammatory drugs (NSAIDs) are pharmacological, dose and duration dependent. Usage patterns of prescription-only (POM) or 'over-the-counter (OTC)' NSAIDs may influence risks, but are not commonly described.
  
  
  METHODS
  The Echantillon Généraliste de Bénéficiaires database, the permanent 1/97 representative sample from the French national healthcare insurance systems, was queried over 2009-2010 to identify usage patterns, concomitant chronic diseases and cardiovascular medication in OTC and POM NSAID users.
  
  
  RESULTS
  Over 2 years, 229 477 of 526 108 patients had at least one NSAID dispensation; 44 484 patients (19%) were dispensed only OTC NSAIDs (93% ibuprofen) and 121 208 (53%) only POM NSAIDs. The OTC users were younger (39.9 vs. 47.4 years old) and more often female (57 vs. 53%); 69% of OTC users and 49% of POM users had only one dispensation. A mean of 14.6 defined daily doses (DDD) were dispensed over 2 years for OTC vs. 53 for POM; 93% OTC vs. 60% POM patients bought ≤ 30 DDD over 2 years, and 1.5 vs. 12% bought ≥ 90 DDD. Chronic comorbidities were found in 19% of OTC users vs. 28% of POM users; 24 vs. 37% had at least one dispensation of a cardiovascular drug over the 2 years.
  
  
  CONCLUSIONS
  Most of the use of NSAIDs appears to be short term, especially for OTC-type NSAIDs, such as ibuprofen. The validity of risk estimates for NSAIDs extrapolated from clinical trials or from observational studies not including OTC-type usage may need to be revised.
authors.affiliation: INSERM U657, Bordeaux, France.
authors.forename: Mai
authors.initials: M
authors.lastname: Duong
authors.forename: Francesco
authors.initials: F
authors.lastname: Salvo
authors.forename: Antoine
authors.initials: A
authors.lastname: Pariente
authors.forename: Abdelilah
authors.initials: A
authors.lastname: Abouelfath
authors.forename: Regis
authors.initials: R
authors.lastname: Lassalle
authors.forename: Cecile
authors.initials: C
authors.lastname: Droz
authors.forename: Patrick
authors.initials: P
authors.lastname: Blin
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004366:Nonprescription Drugs
keywords: drug-related risks; over-the-counter nonsteroidal anti-inflammatory drugs; prescription nonsteroidal anti-inflammatory drugs; usage patterns